枸橼酸钠用于心脏术后连续性血液净化抗凝治疗疗效观察及安全性研究.docx

枸橼酸钠用于心脏术后连续性血液净化抗凝治疗疗效观察及安全性研究徐航1唐无忌2葛敏3陈涛3葛卫红1周长江1（1. 南京大学医学院附属鼓楼医院药学部南京210008; 2. 中国药科大学研究生院南京211198; 3. 南京大学医院附属鼓楼医院心胸外科）摘要目的：探讨枸橼酸钠在心脏大血管手术危重患者血液滤过中抗凝治疗的有效性及安全性。方法：选取在我院心胸外科心脏手术术后行血液滤过须接受抗凝治疗患者50例，随机分为观察组25例和对照组25例，分别给予枸橼酸钠和低分子肝素抗凝，比较两组患者的滤器使用时间，治疗前后每名患者血清Na+、Ca2+、实际碳酸氢根、酸碱度的变化及不良反应的发生。结果：枸橼酸组的滤器使用时间为79.12±14.11h，明显长于低分子肝素组66.23±13.82h（P 0.05），两组患者治疗前后的血清Na+、Ca2+、实际碳酸氢根、酸碱度均无明显差异；对照组出现1例伤口渗血，2例轻度血小板减少，对照组的不良事件发生次数多于观察组(p 0.05) 。结论：在连续性血液净化中局部枸橼酸钠抗凝与传统低分子肝素抗凝相比能有效延长滤器使用时间，减少不良事件的发生，在有效性和安全性方面都更优。关键词枸橼酸钠抗凝治疗血液滤过Comparison of the efficacy and safety of Low Molecular Weight Heparin with that of regional citrate anticoagulation in patients after cardiac surgery TANG Wuji1,2, XU Hang1, GE min3, CHEN tao3, GE weihong1, ZHOU Changjiang1. (1. Department of Pharmacy Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China; 2. Graduate school of China Pharmaceutical University, Nanjing 211198, China; 3. Department of Cardiothoracic Surgery Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China) AbstractObjective: To compare compare the efficacy and safety of Low Molecular Weight Heparin with that of regional citrate anticoagulation in intensive care patients suffering from acute renal failure who has just been through cardiac surgery. Methods: 50 patients with ARF were divided into two groups (the RCA and LMWH group), recived LMWH and RCA respectively. We assessed hemofilter life span, serum sodium serum calcium AB and PH. Result: The hemofilter survival time of RCA which was 79.12±14.11h was significantly longer than that of LMWH(66.23±13.82h, P 0.05). There was no significant difference between serum sodium serum calcium AB and PH(P 0.05). There was one patient of LMWH goup has been found Incision bleeding, two of this group has been through thrombocytopenia. There was significant different incidence of the adverse reaction between two groups（P 0.05）. Co